Moral philosophy, casuistry and the ethics of organ donation (crosspost from CT)

As Harry Brighouse mentioned at CT, I’m sceptical of the value of artificial “thought experiments” in moral philosophy, without having a fully coherent basis for this scepticism. One thing I don’t like about the term “thought experiment” is the implication that the results of such thought experiments constitute data, and therefore that an ethical theory is more satisfactory if it fits such data than if it does not. The way I’d prefer to approach such problems involves an iterative loop, with repeated stages of (i) consider reasonable general principles (ii) compare to intuitions about specific cases (iii) where appropriate, adjust judgements on specific cases (iv) revise general principles to give a better fit to adjusted intuitions. That is, I don’t think either general principles or specific intuitions are trumps.

I thought I’d throw some examples into the mix that might tempt some other CTers such as Kieran into the fray. Harry mentioned the Thomson violinist example as a thought experiment that clarifies reasoning about abortion and obligations to others. As I said, I prefer to avoid such implausible hypotheticals. That leads me to suggest looking at some related non-hypothetical choices.

As a real-life alternative to the violinist question, I’m interested question of whether there are circumstances under which it is morally obligatory to donate blood, or organs, in order to save the lives of others. And, if it is morally obligatory, is the obligation one that can justifiably be enforced by law? For what it’s worth, I think the answer to the first question is “Yes” and to the second is “Probably not”. But a positive answer to the first question would seem to justify a “presumed consent” answer to the second, as applied to organ donation after death (that is, people should be presumed to have consented to organ donation unless they explicitly opt out). Of course, that raises the question of whether such a presumption can be made effectual and whether it would in fact raise donation rates, issues on which Kieran has written quite a bit.

Answers to these questions do not translate directly into answers to the corresponding questions about issues like abortion or foreign aid. But they seem to me likely to give more insight than thought experiments about violinists. And, even if you do want to go hypothetical, it would seem to me to be preferable to stick as closely as possible to reality. For example, to go from a general responsibility to a specific responsibility, consider the following case that is only mildly hypothetical. Consider an organ transplant/blood donation technology that can be applied anywhere but is time-sensitive, so that, in the event of a car crash it must be used at the scene. In the case of a crash where someone is injured through the fault of another, should the person at fault be compelled to donate blood/organs to save the life of the innocent party?

The main reason thought experiments are unsatisfactory is that they do not observe the distinction between the imaginable and the conceivable. Many experiments require you to imagine a set of circumstances, but do not take into account whether those circumstances are plausible. Indeed, it is virtually essential to the concept of the thought experiment that plausibliity seen as entirely unimportant.

When I was doing philosophy, we were always being given scenarios like, “Imagine you live in a world where feotuses float around like spores and embed themselves in peoples’ flesh while they sleep”. (No kidding, we were really given this one.) Or “imagine there are two universes. One is completely empty. The other contains only one being. This being is a sadist, and imagines that its universe is populated with many other creatures who are being horribly tortured. It derives great pleasure from this delusion. Which universe is preferable? Why?”. (This was offered by J. J. C. Smart as a defence of Utilitarianism.)

We were also given J.J. Thomson’s violinist experiment.

The problem with all of these scenarios is that they assume a radical and unconvincing separation betwen facts and values. If you grew up in a world when it was possible for spores to invade your flesh and spawn human embryos, for solipsistic deluded sadists to exist, etc, you would already have acquired a completely different set of moral values that took these possibilities into account, and which would render your current set of moral values – the ones you are supposed to use to evaluate the proposed scenario – entirely meaningless. Meanwhile, those who inhabited a universe where it wasn’t possible for embryos to take root in your body would find our universe similarly incomprehensible – “Imagine a universe in which embryonic spores did not float through the air …”

The fact that you can imagine a train engine that talks does not mean this can form the basis of a rational public transport policy.

I think, JQ, that the answers to all of the questions are no. Morally obliged? There are too many cultural sensitivities fo this to be a yes. Compasionately desired, perhaps, but morally obliged no. Legally enforceable? no. The issues of mortal risk make this unenforceable in an enlightened society. Similarly in the car accident. At the scene fault can rarely be determined absolutely and uncontestibly. Then there are the issues of compatibility and mortal risk to the donor.

An example of where this can go into negative overdrive. I heard the Haitian Prime Minister (I think) being interviewed about the chaos and failure of process in servicing the dire needs of Haitians. In the course of defining the immense difficulties faced by those attempting to help he let slip that there were those who where “helping themselves” with known instances of organ harvesting. Contemplate the moral environment of that.

Here’s a counter example to utilitarianism that doesn’t fly in the face of reality: the coliseum. If the audience of entertained viewers is large enough (eg if the coliseum were televised) then it becomes morally acceptable for a utilitarian.

People have made similar arguments with Jews and Nazi’s (all it takes is enough of the latter to justify the holocaust for a consistent utilitarian).

Although to be fair I either of these circumstances would call for non-trivial effort to change the preferences of the sadistic majority.

I think thought experiments can be useful. For example the ‘ticking bomb’ problem is a prurely imaginery thought experiment but it has practical value in showing that the circumstances where one might wish to torture someone to protect a majority are extremely constrained. The artificial setting helps to clarify things. It is something like a moral model.

I think it also illustrates your point that neither specific examples or general principles alone are sufficient as a guide to action.

Have people been smoking some illicit substance and should I try and get my hands on it? John have you decided to attenn the Big M’s talk on Wednesday or can I give the admission to someone else? By the way have you heard to one of forty per cent of African agriculture disapearing?

@John Coochey
Id say you should try to get your hands on some substance John Coochey. You have heard that ritalin works in reverse for children with ADHD havent you? That is, although it is a stimulant…in those with ADHD it acts as a sedative. Im not suggesting the use of illicit drugs but when someone lives in an alternative reality like yours, perhaps there is a legitimate remedy available.

It’s odd to see the “Ticking Time-Bomb” scenario being championed. Many see it as an enabling fantasy for the excesses of the US administration during the last 10 years.

One problem with the TTB experiment is that it, like so many others, depends on a kind of fictional authoritativeness. How could you be sure you were in this situation, unless you were Bruce Willis? And it’s strange that it seems to be extended to justify preventative detention, sustained acts of torture over many months, in the absence of any actual ticking time bombs.

It’s probably because thought experiments often presume some sort of authorial omniscience that many people complain that they are unrealistic.

Still, calling them “unrealistic” doesn’t really get to the heart of the problem with many of them.

Smart’s “deluded sadist” image appeared in “Utilitarianism: For and Against”, which he co-authored with Bernard Williams. Smart invoked it to demonstrate that non-moral enjoyment could be regarded as an absolute Good, since a universe in which a subject enjoyed, for whatever reason, was preferable to one in which one didn’t .Williams derided it as a “Becket-like image”, with no application to the real world.

The real problem with it, however, is that it falls into the the same kind of question-begging trap that originary myths typically find themselves – it presupposes the moral phenomena it is intended to explain. It simply isn’t possible to have a solipsistic entity with any kind of consciousness. Such an entity would have no conception of other beings, any concept of torture, or for that matter, probably any sense of enjoyment. All these entities presuppose a universe populated with other beings, a moral framework, etc, the very things the experiment stipulates cannot exist.

John makes a start but ought to go further to clarify the need for separation between moral philosophy and political philosophy. I think there is a moral case for torture in the ticking bomb example but that does not mean I think torture should be lawful. Likewise I think there are good moral arguments against abortion but that does not mean I think it should be unlawful. I think there is an extremely strong case for being charitable towards those in serious need but I don’t agree with governments engaging in broad scale wealth and income redistribution.

Most people seem only vaguely aware of a distinction between moral philosophy and political philosophy and often vote according to their personal flavour of the former. They should stop it.

“thought experiments” sounds better than “I think”.
“antidotal evidence” sounds a lot better than “a rumour”.
“ancient philosophy” sounds a lot better than “an old wives tale”.
.
None of us want to be accused of basing our thinking on rumoured old wives tales. Thought experiments based on ancient philosophies that are supported by antidotal evidence. I could live with that.

I think that one question which is not yet satisfactorily resolved is that of “When are we dead?” In the context of organ donation of vital organs this is a troubling one – especially if you are the potential donor!

Think of brain death and coma. How often is someone in a coma really brain dead, as opposed to “unlikely to regain conciousness”? The problem is that the surgeon who is going to extract the organs wants the organs to be as fresh as possible, in the sense that warm ischaemic damage is minimised. If the organs remain in the body too long after loss of blood circulation they may be irreparably damaged.

A natural death isn’t a singular event in time as far as I can see, excepting situations in which the unfortunate thought experiment victim’s body is destroyed almost instantaneously, like in a nuclear explosion with ground zero on top of our unwitting volunteer’s head. In actual fact once the heart stops and blood circulation ceases, the human body begins dying in bits and pieces. For example, the kidneys might remain in functioning condition for quite a while, even as other organs fail irredeemably. Because of this the surgeons need a legal escape clause for declaring someone dead – but not too dead! – so that they may remove the needed organs in as good a state as possible.

In some ways the issues are a reflection in a mirror of the abortion debate with its question as to at what stage of development is a bunch of cells “officially” human.

As I see it the question of ethical thought experiments comes down to what you think ethical values are. If you believe that ethical value is some kind of real quantity that we can know – or even guess – then a thought experiment might be a good way to get a handle on it. However, I’m not a moral realist. I think we can understand the world better without resorting to dualist descriptions.

Ethical values aren’t “out there” properties of the world, they’re more like colours. We say a tree is “green” and we sense a tree is green but there is no such thing as greenness out there: there’s actually a cacophony of different wavelength photons hitting our eyes and none of them are actually green. Greenness is a sensation created in our consciousness, which has arisen because it is evolutionarily adaptive. It’s possible that our eyes might have developed differently. A dog sees 2 colours, a snake sees infra-red, an eagle sees ultraviolet, etc: we might have ended up with a different set of visible wavelength bands in which case trees might not be green at all. The colour bands and colour sensations we ended up with are a compromise of biological costs, primarily the energy and other to build and maintain the visual system, and benefits, like being able to identify breakfast options and subtle emotional changes in other humans. (As an aside, there are many alleles of the genes that code the colour-sensing proteins in our eyes, so colours may vary between people and since one of the genes is x-linked, so up to ten percent of women have an extra type of color receptor, and thus a degree of tetrachromatic color vision.)

Ditto for ethical values. An ethical senses have arisen because it is adaptive. The neurological plumbing isn’t fully figured out yet, but we do know a lot about the ethical sense from things like brain studies (lesions, scans, etc) and from in vivo studies like the trolley experiments and of course, by just listening to the people.

The relevant point that arises from this biological perspective is that our ethical sense only has to be adaptive. It doesn’t have to be – and didn’t arise because it was – logically consistent or comprehensive, either individually or across individuals. (It didn’t even arise because it was right!) Of course humans try to codify it into into some that can be claimed to be consistent and comprehensive, but looking around, you’d have to say that that task is still underway.

This poses a real problem for ethical thought experiments. If ethics really existed out there and were, for example, handed down by the Flying Spaghetti Monster, we might expect them to be logically or mathematically consistent and the thought experiment might work. However, if we have a mixed up collection of primitive ethical propositions in our brains, modulated by culture/experience, that were chosen for adaptiveness 100k+ years ago in African forests, then highly specified thought experiments may well worse than useless.

Let’s take the TTB as an example. This situation is typically formulated to exclude uncertainty – “We know that he knows where the TTB is and it will kill n innocent people by time t” – has a quite different feel from “On the basis of some information we have collected that we think is correct and a bit of added guesswork we think there’s a TTB and we think that one of these guys knows.” However, we know that uncertainty is a significant factor in many ethical judgements. If drunk driving always resulted in death our ethical valuation of it would be different.

So, the pointed thought experiment, may actually only appear to work because it excludes relevant real-world components to create a false certainty. Until such time as we can give a definitive account of what actually is morally relevant we are stuck with our uncertainties and including them will likely get a result we can put more trust in.

@Donald Oats
Donald, there’s some neurological research into the this and it’s made a fair bit of progress to the extent of being able to identify individuals with “locked-in sysndrome” – with the capacity to generate a conscious ego experience and sense the world but unable to respond bodily. Identifying the opposite case, bodies that will never generate a conscious ego experience, now looks possible or close at hand. The popular term “brain dead” is a bit tricky medically, because the “lower brain” function may be very much alive and kicking when higher brain areas are clearly gone for good.

“Brain dead”, of course, remains a useful term for one’s intellectual opponents so will be retained for some time yet.

As far as the iterative process goes could we call such a process “civilisation” or “acculturation”. Maybe we already do.

It’s easy to imagine a religious faith that might be unsympathetic to the idea of mandatory organ donations. Shinto is a real world example with millions of adherents; there are most likely several others. Do proponents of dubious thought exercises in moral calculus blink in the face of widely-held, time-worn religious conviction then? Perhaps they ought.

Thought experiments can be useful if they are close enough to reality; for example, consider (a thought experiment based on a real life) case in which a surgeon has an organ donor on the table, and is about to commence a liver extraction for another patient who is being prepared for imminent transplant. The second patient will die very soon without the transplant. The first patient, the donor, must be dead before the extraction may proceed. This first patient has serious brain trauma and is in a coma. Death, in this context, requires that once artifical respiration and heartbeat maintenance are removed, the patient’s heart stops, breathing stops, and that the surgeon wait several minutes to ensure death has taken place. The surgeon has to make the decision on how long to wait so that while death has taken place, the organs are still viable for transplant.

But, what if after removal of all mechanical assistance the first patient, instead of dying, instead of being “brain dead” which is how they ended up a donor in the first place, what if the patient commences breathing unaided after the surgeon has opened them up? [ Unassisted breathing is an indication of some brain function.]

Should the surgeon continue the liver extraction anyway?
Or, should the surgeon quit on the extraction and suture the first patient back up?

If the surgeon quits, and if the second patient is an organ donor – who we know is close to death – should we instead wait on the second patient to die on the operating table and then use their organs for transplant to others?

It seems to me that the above is a thought experiment that is revealing about how we feel viscerally what is right or wrong behaviour – but if we take a vote on who chooses one course of action versus another I bet there will be nothing like unanimity on the “right” action.

In other thought experiments may be used to examine aspects of what might be considered moral behaviour by an individual. Some though experiments uncover culturally invariant choices – meaning that the choice of a particular action is overwhelming compared to the alternatives, and that that action is the overwhelming choice irrespective of the different cultures of the test subjects tested so far.

I don’t believe in a universal morality; indeed, even the single individual may be able to arrive at contradictory moral choices in two different circumstances separated only by time. I’m no philosopher but I cannot see as yet how morality may be separated entirely from context. While there are some “moral rules” that seem to be widespread, and we all know of the famous “do unto your neighbours what you would have them do unto you” maxim, I doubt that these are any more than a reflection of evolutionarily adaptive behaviours necessary for prosperous survival as part of a social species such as ourselves.

In short, I reckon thought experiments have a role to play. But I would rather go looking at what real people do in real situations, and even more of interest, how various species of animal behave when they encounter various social situations.

@TerjeP (say tay-a)
I think I see what you’re getting at, but I have to disagree. I take it from your comment that you consider “moral philosophy” to mean what you think is right (or wrong) for you to do, and that “political philosophy” (in this context) means what you think is right or wrong for others to do. I know that’s a simplification, but you can’t divide them so easily, as Peter T points out.

I’ve had this argument with a certain kind of libertarian before (not suggesting you are this kind, this topic just reminds me of them). It has been suggested to me that libertarians don’t seek to impose their moral framework on others, in contrast to statists who want to make income redistribution according to an ethical algorithm compulsory, for example, or theocrats who would make their religious principles mandatory for everyone. But it isn’t actually true, it’s a conceit. If Libertopia came about, it will be as much an imposition of a worldview and moral framework as any other system – individual rights instead of social rights; voluntary action instead of majority rule; equality of process instead of equality of outcome.

I have no problem with arguing that this worldview is superior to others, but I won’t pretend that it’s somehow a morally neutral position.

Jarrah – political philosophy isn’t about what others ought to do. It is about what government ought to do and what it ought to be prevented from doing.

I accept that the libertarian worldview is superior but still a minor imposition. However with competitive federalism a libertarian state can exist along side a social democratic state. Libertarians generally make room for this in their formulations whilst social democrats generally want such centralised control that there is no room for the libertarian. In short social democrats and communists tend to be philosophical pigs.

p.s. With the TTB example my moral philosophy says that in such extreme circumstances I will permit myself to break the law and torture the bomber. However my political philosophy says that torture should be an illegal activity for both civilians and government officials. There is no conflict between these two positions. Those that think there is a conflict have not sorted out the distinction between moral philosophy and political philosophy and their thinking is generally weaker for it.

Never had any problem with well thought outm thought experimentsm esp if it helps people to think outside their socialisation. If the underlying principles hold whether using people seeds or not, it still works.